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研究生:何珮綺
研究生(外文):Pei Chi Ho
論文名稱:妥瑞症兒童之健康相關生活品質
論文名稱(外文):Health-Related Quality of Life in Children with Tourette Syndrome
指導教授:林燕慧林燕慧引用關係劉文瑜劉文瑜引用關係
指導教授(外文):Y. H. LinW. Y. Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:122
中文關鍵詞:健康相關生活品質妥瑞症兒童
外文關鍵詞:health-related quality of lifeTourette syndromechild
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背景與目的:妥瑞症(Tourette syndrome)是一種好發於兒童時期的神經生理疾病,其典型病徵為不自主的動作及聲音tic,過去的研究指出妥瑞症兒童在生理/身體層面以及心理層面常存在有一些問題,因此瞭解妥瑞症對兒童整體健康相關生活品質(health-related quality of life)的可能影響相當重要,所謂健康相關生活品質是指個體主觀認為日常生活受到健康因素影響的程度,但目前相關的研究相當少且缺乏和妥瑞症兒童同時期的正常發展兒童作為比較標準,因此本研究的目的為比較妥瑞症兒童與正常發展兒童的健康相關生活品質及探討可能影響妥瑞症兒童健康相關生活品質的因子。方法:採橫斷面設計(cross- sectional design),以方便取樣的方式收取52位6-12歲,目前正在國小就讀的妥瑞症兒童,並依妥瑞症兒童的年齡及性別配對52名正常發展(typical development)兒童做為控制組。以子女健康問卷-家長版50(Child health questionnaire-Parent Form 50, CHQ- PF50)來評估兒童的健康相關生活品質,並以兒童干擾行為量表-家長版(Disruptive Behavior Rating Scale-Parent Form, DBRS-PF)來量化兒童的行為狀況。此外使用耶魯Tic總嚴重度量表(Yale Global Tic Severity Scale, YGTSS)評估妥瑞症兒童的tic嚴重程度。使用描述性統計、獨立樣本t檢定、單因子變異數分析、皮爾遜積差相關
係數作為統計分析。結果:依據主要照顧者所填答的CHQ-PF50,妥瑞症兒童在『生理/身體層面』的「一般健康知覺」及『心理層面』和『家長和家庭層面』所有面向的分數皆比正常發展兒童低(p<0.01),在「生理/身體總分」及「社會心理總分」的得分也顯著低於正常發展兒童(p<0.05和p<0.001)。YGTSS總分和CHQ-PF50的「生理/身體總分」有著尚可程度的負相關(r=-0.29, p<0.02),和「社會心理總分」則有中等程度的負相關(r=-0.57, p<0.01)。此外,中重度tic嚴重度的妥瑞症兒童在「社會心理總分」的分數顯著低於輕度tic嚴重度的妥瑞症兒童和正常發展兒童(p<0.001)。而有干擾行為問題的妥瑞症兒童在「社會心理總分」的得分亦顯著低於無干擾行為問題的妥瑞症兒童和正常發展兒童(p<0.001)。結論:本研究結果大致上和過去研究一致指出妥瑞症兒童的健康相關生活品質比正常發展兒童差,而tic較嚴重或有干擾行為問題的妥瑞症兒童常呈現較差的健康相關生活品質。
Backgrounds and Purposes: Tourette syndrome (TS) is a neuropsychiatric disorder begins in childhood or early adolescence and characterized by involuntary motor and vocal tics. Previous studies indicated the children with TS demonstrated some psychological comorbidities and physical health problems. Therefore, to understand the possible impact on patients’ health-related quality of life (HRQL) is important. HRQL is the subjective perception of the impact of health problems on quality of life. Limited researches have been reported to compare the HRQL of children with TS with concurrent healty control children. The purposes of this study were to compare with the HRQL in children with TS and children with typical development. And examined the influential factors of HRQL on children with TS. Methods: A cross- sectional design was used. A convenient sample of 52 elementary school children with TS ages 6-12 years old participated in this study. For comparison, 52 children with typical development were match-paired for gender and age. Proxy-responded Child Health Questionnaire- Parent Form 50 (CHQ- PF50) was used to assess the HRQL, Disruptive Behavior Rating Scale- Parent Form (DPRS-PF) was used to quantify the behavioral status. Yale Global Tic Severity Scale (YGTSS) was used to assess the tic severity in children with TS. Descriptive statistics, independent t-test, one-way ANOVA and Pearson product-moment coefficient of correlation calculations were used for data analysis. Results: The children with TS demonstrated lower scores than children with typical development on “General Health Perceptions” of physical -related domains and all aspect of psychologic-related and patent/family -related domains. It also showed lower scores than children with typical development on “Physical summary” and “Psychosocial Summary” (p<0.05 and p<0.001). The YGTSS scores have fair degree and negatively correlated with “Physical Summary” (r=-0.29, p<0.02), and moderate degree and negatively correlated “Psychosocial Summary” (r=-0.57, p<0.01). Futhermore, TS group with moderate to severe tic severity shwed lower scores than TS with mild tic severityand children with typical development on “Psychosocial Summary”(p<0.001). Otherwrise, TS with disruptive behavior problem showed lower scores than TS without disruptive behavior problem and children with typical development on “Psychosocial Summary”(p<0.001). Conclusion: Children with TS demonstrated worse HRQL than children with typical development. The children with TS with more serious tic or disruptive behavior often showed worse HRQL.
指導教授推薦書..........................................i
口試委員審定書..........................................ii
授權書..................................................iii
誌謝.....................................................v
中文摘要................................................vii
英文摘要................................................ix
目錄 ...................................................xi
圖目錄..................................................xv
表目錄.................................................xvi
第一章 前言.............................................1
1.1 研究背景...........................................1
1.2 研究目的及假說.....................................6
1.3 名詞定義...........................................7
第二章 文獻回顧.........................................9
2.1 妥瑞症.............................................9
2.1.1妥瑞症的治療方式................................10
2.1.2妥瑞症tic嚴重程度的評估.........................12
2.2 妥瑞症患者常見的健康相關情形......................15
2.2.1 妥瑞症患者的tic.................................15
2.2.2 妥瑞症對患者心理健康的影響.....................17
2.2.3 妥瑞症對患者生理/身體健康的影響................19
2.3妥瑞症患者的生活品質及健康相關生活品質.............21
第三章 方法............................................31
3.1 研究對象..........................................31
3.2 研究工具..........................................32
3.3 實驗步驟..........................................38
3.4 統計分析..........................................39
第四章 研究結果........................................51
4.1 妥瑞症兒童與正常發展兒童健康相關生活品質的差異....51
4.2妥瑞症兒童tic嚴重程度與健康相關生活品質的關連性....51
4.3其他因素對於妥瑞症兒童健康相關生活品質的影響.......52
4.3.1 Tic嚴重程度對健康相關生活品質的影響............52
4.3.2 干擾行為問題對於健康相關生活品質的影響.........54
第五章 討論............................................62
5.1 妥瑞症兒童與正常發展兒童健康相關生活品質的差異....63
5.2妥瑞症兒童tic嚴重程度和健康相關生活品質的相關性以及對健康相關生活品質的影響.............................67
5.3妥瑞症兒童干擾行為問題對健康相關生活品質的影響.....72
5.4研究限制與未來研究方向.............................75
第六章 結論.............................................78
參考文獻................................................79
附錄一 參與研究邀請函...................................86
附錄二 基本資料表.......................................87
附錄三 人體試驗同意書...................................89
附錄四 妥瑞症兒童與正常發展兒童之基本資料...............90
附錄五 問卷填寫人及填寫人教育程度.......................91
附錄六 妥瑞症兒童與正常發展兒童之身心健康狀況(依據家長回報).............................................92
附錄七 妥瑞症兒童與正常發展兒童目前使用藥物情形.........93
附錄八 依據DBRS-PF之妥瑞症組及正常發展組的行為表現....94
附錄九 妥瑞症兒童與正常發展兒童的CHQ-PF50分數及差異...95
附錄十 不同tic嚴重程度之妥瑞症兒童和正常發展兒童CHQ-PF50
的分數及差異.....................................96
附錄十一 有無干擾行為問題之妥瑞症兒童和正常發展兒童的 CHQ-PF50分數及差異..........................97
附錄十二 不同干擾行為問題的妥瑞症兒童CHQ-PF50的分數...98
附錄十三 妥瑞症兒童有無ADHD診斷及干擾行為問題在CHQ-
PF50的分數..................................99
附錄十四 妥瑞症兒童健康相關生活品質中生理/身體總分之逐步
回歸結果.....................................100
附錄十五 妥瑞症兒童健康相關生活品質中社會心理總分之逐步回
歸結果.......................................101
附錄十六 妥瑞症兒童個案基本資料........................102
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